Diagnostic challenges in headache: migraine as the wolf disguised in sheep's clothing. Introduction.

Abstract

Despite incredible growth in the understanding of its pathophysiologic underpinnings and major advances in its therapeutics over the past decade, migraine remains underdiagnosed in the United States. Whereas in 1989 only 39% of migraineurs had received a medical diagnosis of migraine, in 1999 still fewer than half of patients meeting International Headache Society (IHS) criteria for migraine reported a physician diagnosis. This high rate of underdiagnosis is of concern because migraine, when it is not identified and appropriately treated, can substantially impair patients’ quality of life and daily functioning. New data reveal that one significant factor affecting the ability to diagnose migraine is the presence of other headache types (specifically, sinus headache or tension-type headache) or symptoms or conditions that patients or health-care providers interpret as indicative of these non-migraine headache types. This supplement reviews these new data, considers epidemiologic, clinical, and pathophysiologic relationships among migraine, sinus, and tension-type headache, and discusses the implications of these relationships for the diagnosis and clinical management of headache. Diamond’s article1 sets the stage for the other articles in this supplement by reviewing data from a follow-up study …